If this is not a joint account, you may now submit this information to the bank. If it is a joint account, please continue below.

Joint Account Information

First Name

Last Name

Home Address

City

State

Zipcode

Email

Home Phone

Work Phone

Social Security Number

Taxpayer ID Number (if different from SSN)

Date of Birth

I am providing the above information for the purpose of obtaining an account and I authorize you to obtain additional information concerning any of the statements I have made. I also authorize you to make inquiries you feel are necessary to determine my credit worthiness including but no limited to, obtaining credit reports from reporting agencies and other credit information sources.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING
A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activites, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens and account.

What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We will also ask to see your driver's license or other identifying documents.

You may print this form to mail it to the bank with your check to open your new account. Our address is:
Security BankUSA
PO Box 1630
Bemidji, MN 56619